Provider Demographics
NPI:1861558827
Name:SURAJIT CHAUDHURI MD PA
Entity type:Organization
Organization Name:SURAJIT CHAUDHURI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURAJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-483-8361
Mailing Address - Street 1:PO BOX 42907
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-2907
Mailing Address - Country:US
Mailing Address - Phone:910-483-8361
Mailing Address - Fax:910-485-0672
Practice Address - Street 1:1205 CAPE COURT
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4404
Practice Address - Country:US
Practice Address - Phone:910-483-8361
Practice Address - Fax:910-485-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400218207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497727879OtherNPI
NC8922136Medicaid
NC2199331Medicare PIN
F74386Medicare UPIN